Father Baker Manor

In the surveyor’s words

From the most serious findings on record at Father Baker Manor, in the surveyor’s own words.

• Immediate jeopardy, isolatedF760Mar 6, 2026

  Based on interview and record review conducted during a survey, the facility failed to ensure that residents were free of significant medication errors for one (1) (Resident #1) of three (3) residents reviewed for medication errors. Specifically, on 02/23/2026 Licensed Practical Nurse #1 pre-poured 20 residents' medications and administered medications to Resident #1 that were intended for Resident #2. Resident #1 later became difficult to arouse, developed hypotension (low blood pressure), bradycardia (heart beat fewer than 60 times per minute), and a lower respiratory rate which required the administration of Narcan (naloxone, medication used to reverse opioid overdoses). […]

• No harm, potential for more than minimal, isolatedF609Jun 17, 2025

  Based on observation, interview, and record review conducted during an Abbreviated survey (Complaint #NY00383408) the facility did not ensure that all alleged violations involving abuse are reported immediately but not later than 2-hours after the allegation is made if the events that cause the allegation involve abuse, to the Administrator of the facility and to other officials (including to the State Survey Agency) for one (1) (Residents #1) of three (3) residents reviewed for abuse. Specifically, an allegation that a Certified Nurse Aide slapped a resident was not reported to the Administrator in the required timeframe and resulted in delayed reporting to the New York State Department of Health. […]

• No harm, potential for more than minimal, isolatedF610Jun 17, 2025

  Based on observation, record review, and interview conducted during an Abbreviated survey (Complaint #NY00383408), the facility did not have evidence that all alleged violations were thoroughly investigated and did not prevent further potential abuse or mistreatment while the investigation was in progress in response to all allegations of abuse for one (1) (Resident #1) of three (3) residents reviewed. Specifically, there was a delay in initiating an investigation when a staff member reported they witnessed physical abuse of Resident #1, and the accused staff continued working after the allegation was made. Additionally, the facility investigation did not include interviews or assessments of other residents who the accused cared for and statements from all staff involved. […]

• No harm, potential for more than minimal, isolatedF689Nov 6, 2024

  Based on interview and record review conducted during a Complaint investigation (#NY00359145) during a Standard survey completed on 11/6/2024, the facility did not ensure that each resident receives adequate supervision and assistive devices to prevent accidents for one (Resident #106) of five residents reviewed for accidents. Specifically, a gait belt (an assistive device used to help someone move) was not utilized by staff during a transfer as care planned and Resident #106 sustained skin tears to their left forearm. […]

• No harm, potential for more than minimal, isolatedF880Nov 6, 2024

  Based on observation, interview, and record review conducted during the Standard survey completed on 11/6/24, the facility did not establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (Resident #138) of three residents reviewed for enhanced barrier precautions (interventions designed to reduce transmission of multi-drug resistant organisms including gown and glove use during high contact resident care activities). Specifically, a nurse did not wear proper personal protective equipment during care of the resident's feeding tube (a tube inserted into the stomach to provide nutrition). […]